Currency of Practice Hours

Currency of Practice Hours

(To be filled out by an employer only)

This form should be completed by the applicant's direct supervisor or an employer representative familiar with their practice hours. ACMDTT requires this information to verify that the applicant meets the College's currency-of-practice requirements. If the applicant worked for more than one employer or in more than one specialty during this period, a separate form is needed for each.
Section 1: Applicant Information
Applicant Name

FirstLast
ACMDTT #
If known
Practice Name
If different from the applicant name
Applicant Email
The applicant will receive the completed form as a PDF at this email, to upload to their application or send to the College.
Facility/Organization Name
The employer/facility where the applicant practiced. This applies to all years in the table below.
Profession
MRT Specialty
ENP Specialty
DMS Specialty
Section 2: PRactice Hours
- If the applicant has practiced full-time, part-time, or on a casual basis in the specialty, please enter the number of hours practiced.
- Practice hours do not include vacation, sick time, leave of absence or any other paid/unpaid non-practice hours.
- If the applicant has more than one employer or more than one specialty, complete a separate Currency of Practice Hours form for each employer and/or specialty.
- If the applicant did not practice in the specialty that year, enter ‘0’.
- If the applicant was not employed that year, enter N/A.

Record of Practice Hours by Year

Rows	Number of hours worked in specialty
2026
2025
2024
2023
2022
2021

Section 1: Applicant Information